I selected this clinical review on Extrapyramidal Side Effects (EPS) because during my recent psychiatry rotation, I saw a lot of different EPS presentations firsthand in patients, which made the topic feel very relevant to my clinical training. Before this rotation, I mainly associated EPS with antipsychotic use in psychiatry, but after seeing patients experience symptoms like tremors, rigidity, restlessness, and abnormal movements, I realized how significant these side effects can be on a patient’s daily functioning, medication compliance, and overall quality of life. This article stood out to me because it expanded the discussion beyond just psychiatric patients and reinforced how important it is for all healthcare providers to recognize and manage these medication-induced movement disorders early.

Through this review, I learned that EPS is not only caused by traditional antipsychotics, but also by medications we commonly encounter like SSRIs, lithium, and antiemetics such as metoclopramide and prochlorperazine. I was especially surprised to learn that prochlorperazine can have an EPS incidence rate as high as 67%. I also learned more about the pathophysiology behind these disorders, specifically how dopamine $D_2$D2​ receptor blockade in the basal ganglia and mesolimbic pathways contributes to the different symptom presentations and timelines. Acute dystonia can occur within hours to days, akathisia often develops within weeks and causes severe subjective restlessness, and tardive syndromes may become chronic and even irreversible. One of the most important points I learned was regarding akathisia, because it can easily be mistaken for anxiety or worsening psychiatric agitation. If a provider misinterprets the symptoms and increases the dopamine-blocking medication, it can significantly worsen the patient’s distress and increase the risk of self-harm or violence.

This review directly relates to my current clinical experience, especially after completing a psychiatry rotation where these medications were used frequently and EPS was something I encountered regularly. Moving forward, I know I will pay much closer attention to subtle signs of medication-induced movement disorders and make sure to carefully review a patient’s medication list whenever new abnormal movements, agitation, or restlessness appear. I also better understand the importance of early screening tools like the AIMS assessment to identify tardive dyskinesia before symptoms become irreversible. In addition, I now feel more confident recognizing and treating acute dystonic reactions quickly with medications like IM benztropine. Overall, this article reinforced how important it is to closely monitor medication side effects, educate patients and families, and work collaboratively with nurses, pharmacists, and the healthcare team to improve patient outcomes and medication safety.